Pediatric Dental CarePediatric Dental Care

Lawrence Kotlow DDS

Patient comfort and safetyPatient comfort and safety1.1. All children are treated using the most upAll children are treated using the most up--toto--date date

safe technology available.safe technology available.2.2. All oral surgery treatments are completed using up All oral surgery treatments are completed using up

to three different lasers.to three different lasers.3.3. The use of lasers promote healing and reduce post The use of lasers promote healing and reduce post

surgical discomfort.surgical discomfort.4.4. Lasers eliminate the need for sutures in most Lasers eliminate the need for sutures in most

patients.patients.5.5. All treatment is completed using microscopes to All treatment is completed using microscopes to

reduce damage to adjacent oral structures.reduce damage to adjacent oral structures.6.6. All needed xAll needed x--rays are taken using computers and rays are taken using computers and

result in reduced patient exposure to radiation and result in reduced patient exposure to radiation and reduced environmental contamination due to reduced environmental contamination due to elimination of many of the materials and chemicals elimination of many of the materials and chemicals used when taking conventional dental xused when taking conventional dental x--rays.rays.

Updates in Oral Pediatric DiagnosisUpdates in Oral Pediatric DiagnosisAnkyloglossia or Tongue TiesAnkyloglossia or Tongue Ties

Preventive and interceptive

medical/dental treatmentsLawrence Kotlow DDS

Board Certified Specialist In Pediatric Oral Care Since 1974Advanced Proficiency in Erbium Laser Surgery by the Academy of

Laser Dentistry

Is Your Child TongueIs Your Child Tongue--Tied ?Tied ?

AnkyloglossiaAnkyloglossia: An abnormal attachment of the tissue under the

tongue.

Short Lingual frenum on new born

Updates in Oral Pediatric DiagnosisUpdates in Oral Pediatric Diagnosis

Normal anatomy of the underside of a child’s tongue

Abnormal attachment of the frenum on the underside of

tongue

Abnormal attachment of the lingual frenum

Is Your Child TongueIs Your Child Tongue--Tied ?Tied ?

“Traditional teaching has been that the tongue tie is

of little relevance, will have no adverse oral effects, and can be

ignored.”

The significance & treatment of a The significance & treatment of a tonguetongue--tie is often misunderstood and tie is often misunderstood and

misdiagnosed due to old medical misdiagnosed due to old medical misconceptions and methods for treating the misconceptions and methods for treating the condition. This is especially true when the condition. This is especially true when the recommendation in the past often required recommendation in the past often required placing a child into the operating room under placing a child into the operating room under a general anesthesia for an elective a general anesthesia for an elective procedureprocedure..

Is Your Child TongueIs Your Child Tongue--Tied ?Tied ?

Is Your Child TongueIs Your Child Tongue--Tied ?Tied ?Updated oral health information:Updated oral health information:

””Tongue tie, by interfering Tongue tie, by interfering with tongue mobility, can with tongue mobility, can exert a harmful effect on exert a harmful effect on

many aspects of life.”many aspects of life.”Martin Glasson, Dept Pediatric Surgery, New Children’s HospitalWestmead NSW Australia.

Articles and text booksArticles and text booksTo assist healthcare professionals diagnose To assist healthcare professionals diagnose

and treat problems associated with tongue ties. I have publisheand treat problems associated with tongue ties. I have published d articles and contributed a chapter the well respected text “Dentarticles and contributed a chapter the well respected text “Dental al Clinics of North America” , based on my experience and success Clinics of North America” , based on my experience and success in treating this condition. All of this information is availablein treating this condition. All of this information is available for for downloading from my web site.downloading from my web site.

Updated diagnosis & treatment Updated diagnosis & treatment recommendations for tonguerecommendations for tongue--tiesties

Diagnostic Criteria used to Diagnostic Criteria used to determine when a determine when a

Tongue Tongue ––Tie requires revisionTie requires revision..

Diagnostic CriteriaDiagnostic Criteria

The tip of the The tip of the tongue should be tongue should be able to protrude able to protrude outside the outside the mouth without mouth without causing clefting causing clefting of the front of the front border of the border of the tongue.tongue.

Cleft of border of tongue

Diagnostic CriteriaDiagnostic Criteria

The lingual The lingual attachment attachment should not should not create a create a diastema (gap) diastema (gap) between the between the lower front lower front teeth.teeth.

Diagnostic CriteriaDiagnostic Criteria

The lingual The lingual attachment attachment should not should not cause cause excessive force excessive force on the lower on the lower front teeth front teeth causing them to causing them to tip backward.tip backward.

Diagnostic CriteriaDiagnostic Criteria

The lingual The lingual attachment attachment should not should not cause severe cause severe blanching of blanching of the gum tissue the gum tissue behind the behind the lower front lower front teeth.teeth.

Diagnostic CriteriaDiagnostic Criteria

The lingual The lingual attachment should attachment should not prevent a not prevent a normal swallowing normal swallowing pattern. The tongue pattern. The tongue should be able to should be able to lick the lips.lick the lips.

Without the free movement of the tongue many food particles may not be removed by the tongue’s normal sweeping action and correct movement of oral fluids.

Diagnostic CriteriaDiagnostic Criteria

The lingual The lingual attachment should attachment should not prevent a not prevent a normal swallowing normal swallowing pattern. The tongue pattern. The tongue should easily touch should easily touch the roof of the the roof of the mouth.mouth.

Diagnostic CriteriaDiagnostic Criteria

The lingual The lingual attachment attachment should not should not interfere with interfere with nursing or nursing or cause mothers cause mothers pain.pain.

Nursing mother’s can suffer nipple damage, pain

or mastitis,

Please visit my web site or the Academy of Pediatrics web sitefor more valuable information concerning nursing

Diagnostic CriteriaDiagnostic Criteria

An abnormal lingual attachment can interfere with certain eating pleasures !

Diagnostic CriteriaDiagnostic Criteria

Certain Social Activities

Classifications of Tongue-Ties

8-12mm

12-16 mm

Greater than1.5inchsor 16mm

NORMAL RANGE OF

MOTION

CLASS 1 MILD

CLASS II MODERATE

4-8 mm 0-4 mm

CLASS IV- COMPLETECLASS III-SEVERE

In- Office Treatment and Release of Tongue-Tie

Local anesthesia : may or may not be required when revision is completed with the Erbium

laser.

Sutures are usually not required .

Revising the abnormal lingual frenumRevising the abnormal lingual frenum

No numbing was needed for this revision

More severe and thicker revisions More severe and thicker revisions may require numbing and one or two may require numbing and one or two small sutures to prevent the frenum small sutures to prevent the frenum

from reattachingfrom reattaching

Numbing was required for this patient

Placing a dissolvable

suture to prevent

reattachment

One week following laser surgery

Normal oral

healing area

Safe and Simple inSafe and Simple in--office treatmentoffice treatment

Pretreatmentassessment.

Immediately after laser release in the office with

local anesthesia.

Some or all discussed diagnostic criteria maybe apparent upon examination

““Quality of life can be improved Quality of life can be improved by an operation which is simple, by an operation which is simple,

brief, and virtually devoid of brief, and virtually devoid of complications.”complications.”

Updates in Oral Pediatric DiagnosisUpdates in Oral Pediatric Diagnosistoday’s most recent recommendationstoday’s most recent recommendations

Martin Glasson, Dept Pediatric Surgery, New Children’sHospital, Westmead NSW Australia.

Is Your Child TongueIs Your Child Tongue--Tied ?Tied ?

Please feel free to discuss any questions concerning this

abnormality and the treatment needed to correct the problem

with Dr.Kotlow.